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12 Cards in this Set
- Front
- Back
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"diabetes" means:
Defect in Type I, II DM: |
"siphon"
Type I (juvenile, DKA) - autoimmune, idiopathic, B-cells gone, absolute lack of insulin Type II (adult-onset) - defects in insulin secretion/relative lack of insulin, or insulin resistance |
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Classic presentation of T1 DM:
Associated with which HLA's? IGG Auto-Ab's? 5% of T1 DM patients also get what? |
~12 y/o child w/ polyuria, polydipsia, polyphagia, sudden onset, high BS, osmotic diuresis
HLA DR3, DR4 anti-glutamic acid decarboxylase, anti B-cell autoimmune - Addison's, Hashimoto's, Grave's |
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What viruses cause chronic infections of the islets?
Typical case of T2 DM: Concordance in identical twins? Defect in MODY: |
Coxsackie B4, mumps, CMV, rubella
obese adult with elevated fasting glucose/glycosuria 100% glucokinase gene |
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Key lesion in T2 DM:
Pathphysiology? What is produced by adipocytes and able to render muscle/liver resistant to insulin? |
insulin resistance in liver, skeletal muscle
insulin secretion is usually OK, but body can't respond to it, liver continues gluconeogenesis resistin |
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Two little-known hormones implicated in insulin resistance:
What is the Somogyi phenomenon? What is the "dawn" phenomenon? |
amylin, calcitonin-gene related polypeptide (CGRP)
rebound hyperglycemia from stress hormones that spike when BS drops too low from too much insulin hyperglycemia in the morning from high output of HGH during sleep |
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Usual cause of diabetic coma in T2 DM:
Destruction of the islets by exocrine pancreatic disease: diabetes caused by Cushing's syndrome, amylin from pancreatic cancer, stress: darkening of skin in armpits, groin: |
hyperosmolar nonketotic diabetic coma (HONK, HNKK)
pancreatic diabetes endocrine diabetes acanthosis nigricans |
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Pathology in large-vessel disease in diabetes?
Pathology in small-vessel disease (hyaline arteriolar sclerosis)? |
LDL's stick to glycosylated collagen, cause fibrosis
basement membrane of capillaries and arterioles thickens - compromises lumen |
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#1 cause of ESRD in the US:
What is Kimmelsteil-Wilson disease? What combination of drugs work marvellously in preventing diabetic kidney disease? Armanni-Ebstein: |
Type I - diabetic nephropathy
Balls of GBM-mesangial matrix material in the glomerular tuft - highly characteristic of DM or FSGS ACEI's + CCB lots of glycogen in the tubular cells |
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Sorbitol deposition is implicated in what disease?
Most serious diabetic eye problem? 1st change in eyes? What happens in peripheral nerves in diabetes? |
cataracts
diabetic retinopathy microaneurysms axons and Schwann cells die off - sensory loss, paresthesias |
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How do the islets look in T1 and T2 DM?
Hyaline in islets of T1, T2 DM: |
T1 - lymphocytic infiltration, destruction
T2 - often normal T1 - collagen T2 - collagen + amylin |
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What is Hb A1C?
An amp of D50 usually cures which patients? symptomatic hypoglycemia in non-diabetics is due to what? |
glycosylated Hb that can be measured in the blood to check diabetic control
insulin OD, post-prandial T2 DM ("too much too late") epinephrine response to falling BS |
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Whipple's triad:
How to differentiate factitious hyperinsulinism vs B-cell tumor: |
low BS, S/S, OK after giving glucose
measure C-peptide (remember proinsulin) |
